Jan O'Sullivan (Limerick East, Labour)
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I move:

That Dáil Éireann,

expressing its serious concerns about disclosures of major failures in cancer care services at the Midlands General Hospital, Portlaoise, including the failure to diagnose breast cancer in nine women who had presented for mammograms and the recall of a further 97 women who had undergone ultrasound scans at the hospital;

deploring the way in which the women have been treated subsequent to these disclosures, including the failure to provide adequate counselling for those who have had to undergo surgery and the fact that women who had undergone scans first heard on news bulletins that they might be recalled;

noting that concern had previously been expressed about the adequacy of equipment and facilities at Portlaoise;

condemning the failure of the Department of Health and the HSE to ensure the provision of cancer screening and treatment services in which the public can have full confidence;

urging the public, notwithstanding these alarming failures, to continue to present for screening and assessment;

noting that the HSE was the creation of the Minister for Health and Children, Deputy Mary Harney, and that it has failed to deliver the improvements promised in the health service; and

believing in the principle of political accountability for such shocking failures in our health system,

has no confidence in the Minister for Health and Children, Deputy Mary Harney.

I wish to share time with Deputies Joan Burton, Kathleen Lynch and Caoimhghín Ó Caoláin.

I am amazed that the Government's amendment does not propose confidence in the Minister for Health and Children. It refers to a variety of matters, including sympathy and regret, and expresses confidence in the efficiency and high quality of the work carried out in the review of mammograms, approves the actions of the Minister for Health and Children, acknowledges the leadership she has shown and supports her in her commitment to ensuring equitable access to high quality cancer services, but nowhere does it express confidence in the Minister. That is extraordinary. Why is confidence not expressed by the Government in the Minister for Health and Children?

We have tabled this motion of no confidence because the women and their families who have suffered so appallingly are entitled to have their health and lives taken seriously enough for somebody to take responsibility. If political accountability is to mean anything, the Minister, Deputy Harney, must accept overall responsibility for the way these women were treated. Of course she is not responsible for the misdiagnosis. However, she set up the system that has become so focused on itself rather than the patient that, incredibly, it ended up telling the Oireachtas health committee before it told the women themselves that 97 human beings who had been told they were clear of cancer had to be recalled and may, after all, have had the disease when they were referred for tests.

How could it have happened that these women did not get an individual and immediate response as soon as the doubt was known? How was it that their files were neatly stacked up and batched until the number reached 97 to be dealt with as a package? How could it have appeared more important to protect the system by telling the committee than to protect the women by telling them? How is it that, 24 hours later, when the Minister and the nation knew, those women had still not got a telephone call? How could counselling not have been put in place as promised and how could the help-line not be staffed with sufficient personnel to prevent it being swamped? The Minister can have three highly paid advisers on her staff, but only two cancer care nurses could be found to staff the helpline. Every time we think lessons have been learned, something else happens to show that they have not.

What is the Minister's response? She has asked for a report from the board of the HSE which, we are told, will be ready in a few weeks. What kind of response is that to people who have been so badly let down? I acknowledge, as I was chairing the committee meeting, that the Minister did not know any sooner than I that 97 women were to be recalled for ultrasound review. However, she should have known — she is the Minister. The most basic lines of communication and accountability were not functioning. It is inconceivable that the Minister did not keep in regular contact with the investigative process.

The Minister told the Dáil on 7 November that Dr. Ann O'Doherty "has been asked to look over the mammograms, ultrasounds and anything else that is relevant, including the machinery". Last Wednesday, during Question Time, she said in a reply to me that a further two women were diagnosed with breast cancer, in addition to the seven already diagnosed, and gave me to understand that this was the final number. Dr. O'Doherty's brief included ultrasounds. At what point were they transferred to a parallel investigation? Who is examining the 15 year old equipment? If, as we are told, Dr. O'Doherty's report is completed, is it confined to the mammography reviews or is it more comprehensive? How many reports will there be? Is anybody examining why inadequate systems stayed in place despite the letter sent directly to the Minister in July 2005 by Mr. Peter Naughton, a surgeon in Portlaoise, who described the diagnostic services there as "a shambles"? The Minister must be accountable on these matters of vital public concern.

If nobody is considered responsible, no lessons will be learned. An unidentified woman at the ICA public meeting a few days ago expressed what most women in Ireland are now thinking: "If I find a lump or another symptom that worries me and I go for tests, can I be sure that the result I am given is correct?" That is a fundamental question which no woman should have to ask. The latest news that 15 patients at Cork University Hospital, and perhaps others at UCHG, were wrongly diagnosed is adding to the uncertainty. It is essential that trust is restored, but this can only be done by making real and transparent change.

We have been accused of stirring up fears and playing political games. I wish to confront those accusations and refute them. The fear and mistrust are caused by the facts of what has happened. Women's lives have been unnecessarily put at risk. The monstrous bureaucracy, the HSE, set up by the political decision of the Government and the Minister, failed miserably to handle the consequences appropriately and ensure that the focus was on patient care.

It is our job to hold the Minister and the HSE to account. We would be letting down brave women, such Rebecca O'Malley and Susie Long, the Midlands woman who spoke with her back to the camera to protect her family, the mother of four from Kildare who was one of the nine whose mammography was misdiagnosed and who has had surgery, if we did not speak out as strongly as we can. The woman from Kildare, quoted in The Irish Times this morning, said she had no faith in the Minister, Deputy Harney. "I don't think she has a clue how to run the system. I know she didn't do the mammograms but after the way she has handled this whole situation I really do think she should step down," she said. These women were brave enough to stand up and be counted, as we should be. They did so because they wanted to bring about changes.

We are not questioning Deputy Mary Harney's integrity or her commitment. She is an eloquent and persuasive speaker and believes in what she is doing. She is committed to doing what she believes is right for the health services. However, that is part of the problem. She has the ability to persuade others that she is right and, despite the fact that her party got only 2% of the votes of the people, nobody in Fianna Fáil or the Green Party is willing to take on the job. They stand by while the ideologically driven philosophy of the Progressive Democrats hones and shapes the future of the health services. The fact that she cannot be answerable for every detail of the operation of the HSE is a red herring. The present catastrophe in Portlaoise and other crises cannot be passed off as errors by one or more clinicians. They are primarily failures of management in a system established by the political decision of the present Minister and most of the people in the current Government.

Speaking in the Dáil in November 2004 when she introduced the legislation to set up the HSE, the Minister said:

It is a once in a generation event. It is our generation's chance to put patients first in the design of the management of health services. It is our chance to put in place modern, effective management to make the best use of these tremendous resources we are applying to health and to get clear value and clear results for that money.

Later in her speech she said there were two ways Government policy would be judged:

. . . better outcomes for patients and better value for taxpayers' money. To achieve them, we badly need clarity of roles and accountability — political responsibility for the Minister and management responsibility for the management. The lines of responsibility and accountability are clear in this legislation, the clearest they will ever have been in health administration in this country. That will make a real difference to the quality of health services provided for our people.

Three years on, the only thing that is clear is that none of this has been delivered. There is no clarity of accountability, no value for money, no taking of responsibility and, above all, no sense that patients are being put first. The health service has become a huge centralised bureaucracy with hundreds more senior and middle-management personnel than ever existed in the old health board system. When one talks to people — I have talked to many — who work at the coalface taking care of patients, they say that it is much harder now to have decisions made. Morale is low and there is a huge level of frustration with the system.

The HSE should never have been set up in its cumbersome, centralised, top-heavy form. There must be root-and-branch reform, with layers of management taken out and lines of accountability clearly defined, including that of the Minister. Deputy John Gormley, now the Minister for the Environment, Heritage and Local Government, was right when he stated in the Dáil in December 2004 during the debate on legislation establishing the HSE:

This is retrograde legislation. It is a sad day for democracy and this House. In years to come people will ask what the Government was thinking about when it rushed this Bill through. It is clear the Tánaiste wishes to rush it through and to guillotine it because she does not believe in the same democratic values in which we on this side believe.

The Minister, Deputy Gormley, is on the other side now. Will he stand up and be counted on his democratic values? We cannot stand by and see the health service shaped into an entity that provides speedy treatment according to ability to pay, sees patients as numbers, and is run by an organisation whose structure even Government Ministers such as Deputy Ó Cuív cannot fathom. The Government as a whole must take responsibility for the health service rather than allowing it to be run according to the ideology of a tiny party. Backbenchers who are in touch with the concerns of their constituents and those who call themselves Independents should have the courage of their convictions and vote accordingly.

Ireland is a relatively small country, with a population roughly equivalent to that of Greater Manchester. There are successful models for us to follow and we have the money to invest. I acknowledge that a considerable amount of money has been invested in the health services — a greater increase than any other comparable OECD country. However, we cannot continue to lurch from crisis to crisis and watch the loss of confidence of patients and staff. It is possible to re-organise and restructure the delivery of health services to the standard of excellence to which we all aspire. The Labour Party has made positive proposals on how this can be done, particularly by advancing the concept of universal health insurance.

We support specialist cancer centres, but they must be properly resourced. There have been suggestions that we have not been supportive of the proposals with regard to cancer. We are completely supportive of the establishment of specialist cancer centres, but we must be told how they are to be resourced before they become, once again, distanced from the Minister through the HSE and towards Professor Tom Keane. We must know that the resources will be provided and for that reason I am pleased that the Minister for Finance is here listening to me. We have campaigned vigorously for the roll-out of BreastCheck across the country and sponsored whistleblower legislation. We have also called for the establishment of patient safety alert processes, the accreditation and development of laboratory provision in Ireland, clinical audit and the expansion of HIQA's role to cover private as well as public institutions. We want open accountability and equity across the system. These are practical measures that would improve patient safety outcomes, increase confidence in the system, allow people who have concerns to raise them, and ensure constant auditing and reviews of clinical practice in our health service. These are all matters for political implementation and political judgement.

What people want above all is to be able to trust the health services. They want to feel that someone is in charge and that those who give care are enabled and supported in doing so. Responsibility has not been taken in the appalling circumstances of the Portlaoise debacle and I see no evidence of it in the Government's amendment to our motion. Each day new and more shocking disclosures have emerged. Those relating to Cork University Hospital are the latest, and who can say with any confidence that they will be the last?

We still do not have the answers we were promised. In the first week of November, when asked about the O'Doherty review, the Taoiseach told the House: "The review will be completed this week and a full report will be published by the end of November." Today he told the House that the review has not been completed and he did not give any indication as to when the report would be published. Is the report being withheld and, if so, why? It was also reported today that Dr. O'Doherty had never spoken to the consultant radiologist at Portlaoise who was sent on administrative leave when the controversy first broke. As the Taoiseach failed to respond when asked about this today, I now ask the Minister for Health and Children to respond to five specific questions when she speaks in this debate. Has the O'Doherty review been completed? Has the report been submitted to the HSE and the Department? When will the report be published? Did Dr. O'Doherty speak to the consultant radiologist during the course of her inquiry? Finally — this is a question about which I have some concerns, as there is a lot of confusion — was Dr. O'Doherty initially assigned to cover ultrasounds and equipment as well as mammographies? That is what the Minister said initially. The impression given now is that she was not covering anything except mammography. We need clarity on this.

After listening to the Taoiseach today I am more confused than ever. When Deputy Gilmore asked whether Dr. O'Doherty was aware of the fact that Mr. Naughton was doing these reports, the Taoiseach replied that from listening to colleagues, he assumed Mr. Naughton was trying to be sure to be sure. Is that the way to restore confidence? Why exactly was Mr. Naughton looking at the ultrasounds? Was it to do with the O'Doherty report or was it something he took on himself? This is the type of thing that causes confusion and concern among the public.

Does the Minister accept that although money could never compensate the women who turned up for screening, were misdiagnosed and subsequently had to undergo surgery, women who find themselves in this situation are likely to be entitled to financial compensation — probably significant compensation — from the State? Has she sought confirmation of this from the Attorney General?

This has been one of the blackest chapters in the recent history of our public health service, made all the worse by the failure of those in political office to accept their responsibility for the pain, suffering and trauma caused to patients. The reality, as Deputy Gilmore said in the Chamber earlier today, is that the Minister has lost the confidence of the public. She has lost the confidence of those who work in the health service and she has most certainly lost the confidence of those women who put their trust in our health service and who have been so badly let down.

The Taoiseach seemed on the verge of taking a courageous step today by agreeing to have a free vote on this motion tomorrow, before rapidly backing off. He knows as well as I do that if he allowed a free vote the Minister would be clearing out her desk in Hawkins House on Thursday morning. We will not have a free vote, but I still hope there will be some in the ranks of the Independents or on the Fianna Fáil back benches, who have been happy to engage in whispered criticisms of the Minister, Deputy Harney, in the corridors of Leinster House, who will have the courage of their convictions and do the right and honourable thing by supporting the Labour Party motion of no confidence in the Minister for Health and Children.

Joan Burton (Dublin West, Labour)
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I thank Deputy Jan O'Sullivan for moving this motion.

The former US President Harry S. Truman had a sign on his desk which read "The buck stops here". This Government seems intent on ignoring that old-fashioned idea of accountability. The buck stops anywhere but with the Taoiseach and the Minister for Health and Children. The shameful goings-on in our cancer services are probably the greatest scandal to face the health services since the blood contamination crisis. What we know now points to systemic failures, not just isolated mistakes of administration. Systemic failure must be the responsibility of the Minister and the Government of the day. These failures are ultimately life-threatening and life-shortening for a significant number of women, as was the case in the blood contamination crisis.

All the advice that women are given to reduce their chances of dying from breast cancer involves mass screening, early diagnosis and prompt treatment. The women in Portlaoise and the women in Cork University Hospital did what they were advised to do and are now in some cases left in an unbearable situation. They placed their trust and confidence in the HSE, in the health services and in the Minister for Health and Children. The failure to diagnose them properly will undoubtedly lead to much physical and emotional suffering and pain for the women and their families.

First Portlaoise, now Cork University Hospital, where up to 16 women may have been misdiagnosed. This prompts the question. Is what is happening in Portlaoise and Cork simply the tip of an iceberg? Is there systemic failure in the health services? Given what we now know, is it adequate that the HSE should be investigating itself? If one looks back at comparable situations such as the contaminated blood scandal, it was only when there was a full independent examination that the truths and complexities of the situation began to emerge.

The key questions now are as follows. Who knew what, when and how did they respond? Were at-risk women left to wait an unnecessarily long time? Why did 97 women, the Minister for Health and Children and Professor Brendan Drumm find out that all was not well only in a question and answer session in the Oireachtas Joint Committee on Health and Children on Thursday morning last?

On 29 August 29 the HSE informed the Department of Health and Children and the Minister that it had ceased the provision of breast radiology services at Portlaoise, placed a consultant radiologist on leave and set up a review of all breast radiology diagnoses at the hospital from November 2003 to August 2007. This review is to be carried out by Dr. Ann O'Doherty and is due at the end of this month, but we still do not have it. It appears that the HSE, in early September, had asked the local surgeon to review the clinical notes of patients who had ultrasound procedures. Therefore, there were two reviews being carried out independently of each other, but apparently unknown to the Minister and the chief executive of the HSE.

The HSE was developed as a flagship model of a centralised health service. In designing this creature, the Minister confined her role, by choice, to policy, openings and speeches. Like Napoleon, she made provision for an army of administrators who would know everything about the system at any one time, but the sad reality of her creation is that the Minister is now out of touch and the HSE is out of control.

How many staff does it take to change a light bulb in a hospital? That is a fair question. How many Ministers and Ministers of State in the Department for Health does it take to address a crisis? She and her team of four junior Ministers cost the taxpayer in excess of €2 million a year, while the senior executives in the HSE also earn high salaries. It begs the question, are they worth the wages that the taxpayer is paying?

In this tangled mess, three elements stand out: first, the Minister's ideologically-driven desire to have a full for-profit health care industry in this country; second, the role of special interests, corporates and investors seeking the lucrative tax breaks and contracts arising from the Minister's initiatives such as co-located private hospitals; third, the loss of morale among frontline workers such as doctors and nurses who are becoming increasingly alienated from a Minister and a management that appears weighed down by incompetence and over-administration. There is now a toxic mix at the top of the health service — arrogance, notions of impregnability and exhaustion as one crisis follows another.

The worry used to be that staff in hospitals were not washing their hands. Now we see the Minister washing her hands and refusing to take responsibility for the crisis.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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That is ridiculous.

Joan Burton (Dublin West, Labour)
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Truman said that the buck stopped here. Is the Minister prepared to acknowledge that the buck should stop with her? For the sake of the people of Ireland, the time has come for her to go.

Kathleen Lynch (Cork North Central, Labour)
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I was a member of what is now deemed an old-fashioned system, the old health boards. Old-fashioned as the system was, as members we could hold both the consultants and the administrators to account, and the people could come directly to us, as public representatives, and tell us their concerns. In came a new broom, deciding to get rid of these old tired administrations and put in place a new executive and a new model. The only aspect removed from the old health board system was the democratic voice. The then chief executive officer of the Southern Health Board still works in the HSE, I believe as an information technology manager. The only aspect missing is the voice of the people. That, to me, was ideological. I do not have a difficulty with ideology — I myself hold one — but that was the ideology of the right. The Minister takes a health service and decides to put it at arm's length, then it goes beyond her grasp and, ultimately, out of her control.

There is no one who can tell the story of what happened to these women better than themselves and we listen to them day on day on the television. First, there is the awful dread of going to the clinic because the doctor suggests it or because one has found something. Some get the relief of being told everything is fine, but all of a sudden they are plunged back in again. I do not believe they will ever recover confidence. There will always be that nagging doubt. Was the first test correct, was the second test correct or will there be another test? That is really the position in which we find ourselves. Once a matter is out of one's control it is difficult to get it back.

It was not just cancer services for women that prompted the tabling of this motion, even though that was the straw that broke the camel's back. I want to read to the House a letter I received which I read only on Sunday night. Despite the late hour, I rang the man concerned because I was so horrified by what I read. I will skip over most of the detail because I do not want to identify anyone. It states:

I was diagnosed with Multiple Sclerosis about 18/19 years ago. My consultant neurologist is . . . (CUH) [in Cork].

My most recent appointment with . . . [my consultant] was on 1st August 2007 at which time it was decided to change my medication . . . [The medication I was on was] . . . self-administered whilst . . . [this new medication would have to be] administered in the Day Procedures Ward (DPW) at CUH on a monthly cycle. I was informed that it would necessitate foregoing all other treatments for a period of 8 to 10 weeks before commencing the new treatment. I was prepared to go without medication for the stated period.

For the last number of years I have been self injecting every second day and the progression of the disease has been slowish. I am hopeful that the administration of . . . [the new treatment] will slow it even more.

I expected to start the . . . [new] regime in late September or early October. It didn't happen. I asked when the treatment was scheduled to start and I was told that a backlog had developed and no schedule was yet forthcoming. This was further exacerbated by the fact that the Day Procedures Ward was closed for the school's mid-term break. Why a busy hospital ward should close to coincide with school holidays is beyond me.

Other treatments require administration on a regular basis, be they weekly, bi-weekly or monthly.

It seems it is now this man's fate that his new treatment will not start until the end of January. At that stage he will be 26 weeks without treatment, all because they cannot get the day procedures ward to open. That ward will close again entirely for two weeks at Christmas to coincide with holidays. All he asks is. . . . . .

. . . a fair chance to maintain a reasonable quality of life, to maintain my independence, to continue working productively and not be a burden on my family or the state. The 'fear factor' is taking hold of my life; every stumble or fall, every pain or ache and every time I don't feel quite right bring doubts rushing into my mind as to whether this progressive disease is progressing and no one is helping me to stop it.

There are two responsibilities in this area. One is political and the other is in respect of people earning large salaries to deliver a service to the people, but no one is living up to these responsibilities.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Sinn Féin Deputies support the Labour Party motion of no confidence in the Minister for Health and Children, Deputy Harney. We have also tabled our own motion of no confidence, which states:

That Dáil Éireann, noting:

the scandalous misdiagnosis of women who were screened for cancer in the Midlands region;

the crisis in cancer care including the inadequate provision of radiation oncology with cancer sufferers having to travel inordinate distances for treatment, the long delay in delivery of promised centres of excellence, the diminution of existing cancer services in local hospitals in advance of that delivery, the flawed plan for location of these centres, leaving whole regions inadequately served; and

the apartheid in our health services which sees private patients able to gain speedy access to diagnostic services for cancer while public patients must join long waiting lists;

has no confidence in the Minister for Health and Children, Deputy Mary Harney.

The motion of no confidence we are debating has been made necessary by the extraordinary revelation at the Joint Committee on Health and Children meeting last Thursday that 97 women in the midlands needed to be recalled after their ultrasound scans were reviewed. "Appalling" is the only word to describe the plight of those 97 women who heard the news through the media. They heard it that way because it was revealed for the first time in a public presentation by a HSE official at the committee. Subsequently, we had the most extraordinary situation where both the Minister, Deputy Harney, and the chief executive of the HSE, Professor Brendan Drumm, stated that the public presentation was the first they had heard about the review of the ultrasound scans.

There is no public confidence in the Minister or the policy and management of health services by this Fianna Fáil-Green Party-Progressive Democrats Government. The scandalous situation in the midlands, which has seen women misdiagnosed after cancer screening and then treated deplorably by the HSE, demands that Deputies of all parties hold the Minister and the Cabinet accountable. Each Deputy has the opportunity at the vote tomorrow night to show where he or she stands on the crisis in cancer services and the shambles that is the health system presided over by this Minister, Taoiseach and Cabinet. The Minister and her colleagues in the Cabinet are responsible for the fundamentally flawed policies and gross mismanagement that has led to such situations. Fianna Fáil and the Progressive Democrats have had more than a decade to deliver the world class health service they promised. Instead, they have maintained a two-tier system riddled with inefficiency and inequity.

In countless written replies to Dáil questions, the Minister stated that the funding, management and delivery of health and personal social services are the responsibility of the HSE. It could not be clearer. Between them, the Minister's Department and the HSE have failed miserably in terms of the effective and targeted funding, the proper management and the patient-centred delivery of cancer services. In the case of diagnostic services for women in the midlands, the failure has been catastrophic.

The crisis is not confined to the midlands. Questions have been raised about other hospitals and professionals. Thousands upon thousands of women are being put through emotional turmoil as a result. It is not confined to the 3,000 whose mammograms were reviewed in the midlands. Thankfully, the majority have been given the all clear, but these women were put through an unnecessary ordeal and others may face the same as the dysfunction in diagnostic cancer services is unravelled.

When the Dáil debated the cancer services crisis on 7 November, I highlighted the concerns of the Well Woman organisation over the ongoing outsourcing of smear tests for cervical cancer to the United States for analysis and the absence of any clear information as to what cytology laboratories will be used to underpin the national cervical screening programme from January 2008. I want to flag that issue again because I did not get adequate answers from the Minister when she replied to the debate. I hope that further grief and tragedy are not being stored up for the future with the approach taken to this vital area of women's health.

Speaking in the debate to which I have referred, the Minister stated that patient safety should come first. We are in total agreement. She stated patient safety should come before hospitals, constituencies and the professions. That is also correct. It has been and must be the priority for us all. The difference is that the Minister has been in the responsible position for a long time. She cannot shirk her responsibility or that of her Department or the HSE for this situation. The HSE is charged with maintaining standards and managing the health services. This crisis in diagnostic cancer services should never have arisen in the first place and a shadow has been cast over those services for all women.

Let it not be forgotten that the issue here is not confined to the competence of health professionals or the suitability of our cancer care infrastructure and its location. This is also about access to services and how our grossly inequitable two-tier health system affects access. The late Susie Long, as a public patient, was denied speedy access to a diagnostic procedure that, if received in time, could have detected her cancer and saved her life. That courageous woman took the decision to highlight her plight nationally, not to seek personal redress for herself and her family but to expose the apartheid in our health services. This apartheid saw patients with access to private care being diagnosed in time, while Susie's diagnosis was too late. How many more Susie Longs have there been? How many in the area of cancer care alone? How many in other areas of care where there are two waiting lists and two parallel systems, public and private?

It is deeply ironic that Professor Tom Keane, the new interim director of the national cancer control programme, should have come from British Columbia in Canada. As one eminent commentator on the Irish health services has stated: "Canada has a strongly egalitarian, one-tier system of health care, which delivers results; life expectancy in Canada exceeds the EU average by over a year for women and nearly two years for men." That system is in total contrast to the two-tier system that exists in this State. As the Irish Congress of Trade Unions states in its study, How Ireland Cares: "The existing State subsidies and tax incentives and the existing organisation of the health care system subsidise private care and discriminate against those who depend on the public system."

The Minister is reported to have complained to an RTE executive about the number of times leading oncologist Professor John Crown was appearing on the station. This was in the days before he was dropped from a "Late Late Show" panel. Far more interesting than the row about the television programme was what Professor Crown himself had been saying. In a recent interview in An Phoblacht, he was asked what he considered the greatest single deficiency in the health service. He stated:

The single biggest deficiency is inequity. It is deliberately engineered. We have a two-tier system because the people running it want a two-tier system. The number of people availing of the public system will decline. The number of people going private is getting bigger.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy has one minute remaining.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is clearly a message the Minister and her Cabinet colleagues do not want the public to hear. They are privatising by stealth while pretending to defend the public health system, but early in her role as Minister, Deputy Harney——

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy's time has expired.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——showed her true Progressive Democrats colours. She said in 2004 that she believed in "a minimalist role for the State in all our lives, including health care". The following year, she stated: "More and more people are getting private health care is a good thing. It is a sign of increasing disposable income."

My time has expired and I am sorry the Ceann Comhairle did not give me an indication earlier.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I did, but you were not listening.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Not only should the Minister go, as I have made patently clear from her appointment following the recent general election, but she should not have been appointed in the first place.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I move amendment No. 1:

To delete all the words after "Dáil Eireann" and substitute the following:

expresses its sympathy and regret to the women who were patients at the Midland Regional Hospital at Portlaoise and their families, who were affected by errors of misdiagnosis and miscommunication;

deeply regrets, most particularly, that a review of diagnoses became necessary;

expresses its confidence in the efficiency and high quality of the work carried out in the review of mammograms and at the special clinic at Portlaoise by leading clinicians, supported by specialist nurses and other health service staff;

approves the actions of the Minister for Health and Children in ensuring that the special clinic was put in place immediately last weekend;

acknowledges the leadership shown by the Minister for Health and Children in setting a clear direction in the National Strategy for Cancer Control for the development of quality assured cancer control services as the best way of ensuring that the risk of such events is minimised in the future; and

supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country;

in particular, Dáil Éireann acknowledges:

the Minister's approval of National Quality Standards for Symptomatic Breast Disease Services under the Health Act 2007 to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible outcome;

the significant progress made to date by the HSE in reorganising breast cancer services in order to comply with the National Quality Assurance Standards for Symptomatic Breast Disease, including the recent decision by the HSE to cease breast cancer services at a number of hospitals with very low case volumes;

the plans over the next two years to provide breast cancer services in line with the development of quality assured capacity in the eight designated cancer centres;

that cancer survival is improving in Ireland for all of the major cancers and that relative survival for breast cancer improved from 72.9% (for people diagnosed between 1994-1997) to 78.2% (for people diagnosed between 1998 to 2001) in line with improvements that have been seen in other developed countries;

the establishment by the Minister of a National Cancer Screening Service Board and the commencement last month of the BreastCheck screening process in the south and west;

the appointment by the HSE last week of Prof. Tom Keane to lead and manage the establishment of the National Cancer Control Programme to implement the National Strategy for Cancer Control;

the additional investment of over €1 billion in cancer control since 1997; and

that the National Development Plan 2007-2013 includes major investment in the implementation of the Cancer Control Strategy, including state of the art diagnostic and treatment facilities.

I do not want to be side-tracked by some statements made by Deputy Ó Caoláin, except to say that no such conversation took place with an RTE executive.

If no confidence motions and political rows could solve our health service problems, we would have the most perfect system in the world. The former health boards would be renowned all over the world, with other countries rushing to put such a model in place. The reality, however, is that politics in recent years has bedevilled health care policy.

I have had the privilege of being elected to the House on nine occasions by the people of west Dublin. On nine separate occasions, they have placed their confidence in me, a confidence I take seriously. The faith and trust they place in me is not just an issue now but an issue for me every day. On four occasions I have had the privilege of being appointed to Government and received the confidence of the House, a privilege I take seriously. It is a great honour and I defend the decisions of the Government as a loyal colleague should. If I could not do that, I would not stay in the Government. If any action of mine compromised patient care, led to a misdiagnosis and delayed treatment for a patient, the Opposition would not have to put down a motion of no confidence. It simply would not arise.

The issue of cancer care and health care reform is as fundamental to our society today as resolving the Northern Ireland problem was for many years. I am not naive and seeking a carte blanche on the health care issue but I invite the leaders of the Opposition to consider a bipartisan approach on cancer services. Our citizens deserve that we do that.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister should start with the man beside her, the Minister of State, Deputy Devins.

Mary Harney (Dublin Mid West, Progressive Democrats)
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In everything I have done since I became the Minister for Health and Children, I have put patients first. Tonight, I apologise to the patients of the former Midland Health Board, particularly those at Portlaoise Hospital. I apologise for the anguish and distress caused. I want in particular to apologise to the nine women whose treatment was delayed as a result of misdiagnoses. I want to apologise to those women, who last Thursday first heard on the airwaves that there was an issue relating to ultrasound diagnosis. That should never have happened and it will not happen again. I have ensured that from here on in, patients will hear directly from the HSE before ever hearing it on the airwaves.

Alan Shatter (Dublin South, Fine Gael)
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The Minister should apologise for setting up the HSE.

Brian Cowen (Laois-Offaly, Fianna Fail)
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A little respect from the Deputy. He is not long back in here.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yesterday, I said I would not quit and walk off the stage, and tonight I will tell the House why.

Since I became Minister for Health and Children, putting patients first is important to me. When introducing new legislation on medical practitioners, Ireland was the first country to put a lay majority on the fitness to practise committee. In seeking that I faced huge vested interests from within the House and outside it. I was asked why were we doing it first before any other country but I am happy other countries are now following suit.

We introduced a provision for public hearings on fitness to practise committee meetings. Why? It was done to put patients first. Lay majorities have been appointed to the councils for health and social care professionals and the Pharmaceutical Society of Ireland that governs the pharmacy profession. The same will be done with An Bord Altranais.

A redress scheme for the victims of Dr. Neary, whose files disappeared, and who have no opportunity to vindicate their rights in the courts was introduced. What a great pity there was no review of the activities in the maternity unit of Our Lady of Lourdes Hospital, Drogheda, for 25 years. Blaming me for what happened in Portlaoise is like blaming the 13 health Ministers who presided when those activities were going on in Our Lady of Lourdes Hospital.

In appointments I have made, I have sought to put patient advocates on various boards. Jane O'Brien from Positive Action was appointed to the Blood Transfusion Service Board.

Emmet Stagg (Kildare North, Labour)
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A Progressive Democrats hack.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Sheila O'Connor from Patient Focus was appointed to the board of HIQA, while another member of Patient Focus was appointed to the board of An Bord Altranais. Patients advocates have also been appointed to the boards of the health and social care professionals.

I have established a Commission on Patient Safety and Quality Assurance, chaired by Dr. Deirdre Madden, to advise me on what policies and legislation are needed to further protect patients. We need to accredit and licence the provision of private health care facilities. All these have been done with one concern in mind — patient safety. When it came to the siting of the new national children's hospital, I backed a single location even though a hospital in my constituency was adversely affected. As Deputy Tuffy will testify, I faced a vicious and anonymous political campaign on that matter during the general election. I single out her and Deputy Curran for dissociating themselves from the viciousness of that campaign. I am not an ideological fool or politically naive. I have made these decisions for one reason — patient safety.

I first became aware of the issues at Portlaoise Hospital on 29 August. I was informed the HSE had suspended the mammography service at the hospital. I commend the director of nursing at the hospital who wrote an important letter on the matter on 15 August. Had she not done so, it would still be going on. I salute her courage. We need more people like her in our health system, like the two midwives in Our Lady of Lourdes Hospital in Drogheda who were very courageous in the Neary case.

Alan Shatter (Dublin South, Fine Gael)
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The Minister tries to silence those who are courageous in speaking out. She has muzzled consultants and doctors around the country.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Deputy Shatter should be courteous.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Minister, without interruption.

Alan Shatter (Dublin South, Fine Gael)
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It is outrageous. The Government is trying to muzzle everyone in the health services.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy has no manners even with all his education.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Minister, without interruption.

Alan Shatter (Dublin South, Fine Gael)
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The Minister cannot have it both ways in muzzling people and then welcoming them as whistleblowers.

Mary Harney (Dublin Mid West, Progressive Democrats)
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After 29 August, when I was informed of a review to be carried out by Dr. Ann O'Doherty. She reviewed clinical evidence of 3,027 mammograms. Up to 2,000 of those women also had an ultrasound but she was reviewing the mammograms. As the House knows, she completed her review and submitted it to the HSE last Friday. The HSE has sought legal advice on the matter.

Dr. Ann O'Doherty was not reviewing professionals but clinically reviewing mammograms. She found nine cancers from the mammograms reviewed. As Mr. Hill said yesterday, she and her team did in a couple of weeks what would normally take a couple of years. I compliment her on this.

I have not seen her report. Deputy Reilly has contacted my office on this but I am not entitled to see the report. It must be cleared by lawyers before it proceeds. There are large issues with reports of that kind. Her job was a clinical review of the mammograms. As a result, nine patients were diagnosed with cancer.

On 7 November, I apologised in the House when we had a full debate and I answered questions for one hour. Last week, I answered questions on the same matter in the Seanad.

On ten different occasions, the Department of Health and Children, on my behalf, were on to the HSE about Dr. O'Doherty's review.

Joan Burton (Dublin West, Labour)
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Did the Minister know about the other review?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will deal with that.

Batt O'Keeffe (Cork North West, Fianna Fail)
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Will Deputy Burton give the Minister a chance?

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Burton, you were heard in silence and the Minister must be too.

Mary Harney (Dublin Mid West, Progressive Democrats)
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On ten separate occasions, we were on to the HSE about the review. Last Wednesday during Question Time, although no oral question was going to arise on Portlaoise Hospital, Deputy Jan O'Sullivan tabled a question about the appointment of Professor Keane. I assumed the Deputy would ask a supplementary question, which she did, and I wanted the latest information.

I was informed nine cancers had been diagnosed — seven originally and then two more — and all women had been seen, the last one on Wednesday morning. In good faith I gave this information to the House. When my officials were on to the HSE, they were informed about the ultrasound review. They did not know what this meant and neither did I. All Wednesday evening I sought to get information from the HSE. I had my deputy medical officer and the Secretary General involved but we were not in a position to give any information last Wednesday. The first time I heard that Dr. Naughton had commissioned a report in respect of approximately 567 ultrasounds was last Wednesday evening.

Joan Burton (Dublin West, Labour)
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Did the HSE not commission it?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I did not know the number and the first time I knew——

Charles Flanagan (Laois-Offaly, Fine Gael)
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What happened on 31 August?

Alan Shatter (Dublin South, Fine Gael)
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The Minister has created a dysfunctional bureaucracy and she is blaming the bureaucracy she created.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister has created a monster.

Alan Shatter (Dublin South, Fine Gael)
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The Minister has created a dysfunctional bureaucracy that is accountable to nobody. That is a classical reason why it does not work.

Joan Burton (Dublin West, Labour)
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On a point of order——

Mary Harney (Dublin Mid West, Progressive Democrats)
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Do Deputies want to hear me or not?

Joan Burton (Dublin West, Labour)
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——was Dr. Naughton's review undertaken on his own initiative or was the HSE party to that review and what did the Minister and the HSE know?

John O'Donoghue (Kerry South, Ceann Comhairle)
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That is not a point of order, as Deputy Burton well knows.

Joan Burton (Dublin West, Labour)
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That is a critical issue.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Some of the Members opposite are lawyers — Deputy Shatter is — and they should at least give me a chance to defend myself and put forward the record.

Deputies:

Hear, hear.

Mary Harney (Dublin Mid West, Progressive Democrats)
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In any civilised society one can put forward one's case.

Alan Shatter (Dublin South, Fine Gael)
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The Minister can do that, but she should admit responsibility for creating the HSE.

Deputies:

Will the Deputy give the Minister a chance?

John O'Donoghue (Kerry South, Ceann Comhairle)
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I will have to ask Deputy Shatter to stop interrupting.

Mary Harney (Dublin Mid West, Progressive Democrats)
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In response to Deputy Burton, as I understand it, Dr. Naughton decided to undertake this review but he informed the HSE locally. It was aware at regional level and I am not trying to say it was not. I was not aware. My Department was not aware, despite being in contact with the HSE on ten different occasions about this matter. Neither the head of the HSE nor the head of the hospitals office was aware of it. I was as shocked as anybody else at the committee meeting last Thursday morning when the details of this matter were revealed. I was quite surprised that almost two hours had elapsed before it was raised. That is the fact. That is being honest.

I went from that committee meeting to a meeting I had convened of 20 senior breast specialists with Professors Keane and Drumm. I had organised this meeting several weeks ago because Professor Keane was coming to Ireland and I thought it would be a good idea to enter into dialogue with key clinicians about the implementation of our new strategy. At every chance I got at that meeting, I sought to put in place a solution to what had emerged at the committee meeting. I asked the HSE to telephone people, to visit people. I spoke to Mr. Hill, who said he would go on Saturday to see the people. I was working on all of that last Thursday afternoon and that is a fact.

When I was coming home from that meeting later that night I had the privilege of listening to Deputy Jan O'Sullivan on "Newstalk" — I have a recording of the programme here. She said the Minister should not resign, that would be completely the wrong focus, and that we have to focus on the women concerned. I do not know what happened between 11 p.m. on Thursday night, when I heard the Deputy, and next morning.

Jan O'Sullivan (Limerick East, Labour)
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I did say that.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I presume the people in the Deputy's party——

Jan O'Sullivan (Limerick East, Labour)
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I wanted the Minister to have an opportunity to take responsibility. I listened to her the following morning and it was after that I decided on the motion.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am just telling the Deputy what I heard and I was impressed that she was focused on the women because that was my focus.

Jan O'Sullivan (Limerick East, Labour)
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I was, and that was the appropriate focus at that moment. I was also hoping that the Minister would have the opportunity to respond.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputies cannot continue a conversation like this. Deputy O'Sullivan should allow the Minister to proceed.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I wish to deal with Portlaoise. In 1996 a Fine Gael Minister, Deputy Noonan, presided over a cancer strategy which designated Tullamore as the centre of excellence for the midlands. The health board was asked to appoint a regional medical director to oversee the implementation of the strategy and Dr. Donal Hollywood was appointed.

In 1998 a meeting of the health board took place at which it overturned his recommendation to appoint a medical oncologist and a haematologist to Tullamore hospital, with sessions in Mullingar and Portlaoise. The health board said it wanted the haematologist in Mullingar and the medical oncologist in Portlaoise. The members of the health board came with a deputation to the Minister, who at that stage was Deputy Cowen, and the National Cancer Forum was involved. The medical director and everyone else said it was the wrong strategy. The health board reversed the decision in favour of Tullamore. Then Deputy Charles Flanagan applied for a High Court injunction which was dismissed on the basis that it was futile. These are the people who tell me they want centres of excellence but when we seek to put one in place——

Charles Flanagan (Laois-Offaly, Fine Gael)
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No. The Minister should tell us about the next five years.

Brian Hayes (Dublin South West, Fine Gael)
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What happened after that?

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Charles Flanagan will have his own chance to speak.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister should go through the next five years before she throws the political mud around the place.

Brian Hayes (Dublin South West, Fine Gael)
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What happened after that?

Seán Barrett (Dún Laoghaire, Fine Gael)
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Who controlled the health boards in any event?

Deputies:

The Minister's colleagues.

Charles Flanagan (Laois-Offaly, Fine Gael)
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That was approximately ten years ago.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister can continue her story.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have half an hour to reply.

Ruairi Quinn (Dublin South East, Labour)
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I would not go there if I were the Minister.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Three different hospitals got a little bit of the action, so when over €7 million was made available——

Brian Hayes (Dublin South West, Fine Gael)
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The Minister's party was in charge then.

Alan Shatter (Dublin South, Fine Gael)
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The Minister has been in Government for almost 11 years. It is laughable.

Charles Flanagan (Laois-Offaly, Fine Gael)
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Why not go back to 1937?

Mary Harney (Dublin Mid West, Progressive Democrats)
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When €7 million was given for the strategy it had absolutely no effect because one cannot divide the kind of specialist service that a region requires between three hospitals.

Brian Hayes (Dublin South West, Fine Gael)
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It is a pity that the Minister did not tell that to the Minister of the time.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister should take control of her Department.

Olivia Mitchell (Dublin South, Fine Gael)
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Did the Minister not know that?

Deputies:

Was Deputy Cowen the Minister at the time?

Seán Barrett (Dún Laoghaire, Fine Gael)
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The Minister should not run away from her responsibilities.

Joan Burton (Dublin West, Labour)
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The Minister's party was in power.

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is what happened.

I want to address the parties opposite because I have heard a lot about cancer care. On 30 January last the Labour Party and Fine Gael published their blueprint for health, the 'Mullingar accord' with 12 priority points, to great fanfare and so on. Was cancer No. 1, No. 2 or No. 3? No. Was it even No. 12? No. Not even a cursory mention of cancer care appeared in the 12 priorities of their blueprint.

Olivia Mitchell (Dublin South, Fine Gael)
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So now it is our fault?

P J Sheehan (Cork South West, Fine Gael)
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The Minister did not know the public was——

Mary Harney (Dublin Mid West, Progressive Democrats)
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This illness will affect one third of our population. That is the reality.

Alan Shatter (Dublin South, Fine Gael)
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The policy the Government promised at the time of the last election was the one it promised for the preceding six years and has not delivered.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We now have a strategy that Professor Keane has described as being among the best in the world. He has said so to me and to many others and I understand that this evening he said it on television. The authorities in British Columbia said the same and they have one of the best organised cancer care systems in the world, which I have visited. Professor Keane spearheaded the implementation of that strategy and thankfully they have seconded him to help us implement our strategy. I salute those who have been involved in the strategy, many clinicians, my officials who are modestly here, people from the Irish Cancer Society, from Europa Donna and many of the patient groups that have a significant interest in this area. According to a world renowned clinician who has come to oversee the implementation of our cancer control programme we have among the best strategies he has seen in the world.

We must, however, move from strategy to implementation. Strategy will not guarantee success to patients. If it is not being too dramatic, I want to be able to look any patient I meet in the eye, anywhere in the country, woman or man, from urban or rural areas, and to say to them we are putting in place a cancer programme that will deliver to them the best possible outcome, the best chances of survival.

Charles Flanagan (Laois-Offaly, Fine Gael)
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I will bring the Minister to meet a few of them tomorrow.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Why would anybody go with something different? There are 250 evidence-based clinical reports from clinicians around the world to the effect that one's chances improve 20%. That means that one in five people would die if not treated in a centre that can deal with volume and quality and have all the sub-specialists working as part of clinical teams.

Emmet Stagg (Kildare North, Labour)
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The Minister needs to tell the Minister of State, Deputy Devins, about that.

P J Sheehan (Cork South West, Fine Gael)
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Doctors differ and patients die.

Emmet Stagg (Kildare North, Labour)
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The Minister should tell her Minister of State. We will support her.

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is what specialist centres are all about. It is not about centres of excellence. Every hospital in Ireland should be a centre of excellence. This is about specialist centres where key specialists work together as part of a team diagnosing cancer and, where surgery is necessary, performing that surgery.

Ruairi Quinn (Dublin South East, Labour)
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The Minister should try to convince Deputy Devins of that.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Much of the follow up, such as chemotherapy, can happen in other places. Why would we not go along with that, given the clinical expertise in Ireland and all over the world? What are we putting first?

Joan Burton (Dublin West, Labour)
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Private hospitals.

Michael D Higgins (Galway West, Labour)
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The problem in Sligo is an old chestnut.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Why would we not go along with the implementation of those plans?

Brian Hayes (Dublin South West, Fine Gael)
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Ten years later. Why did the Minister not do it ten years ago?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I wish we had done it ten or 20 years ago, but we are where we are and we are going to do it now.

Olivia Mitchell (Dublin South, Fine Gael)
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Why does the Minister believe it now?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We are not going to be deflected from putting in place the best possible cancer plan for the patients of this country.

Emmet Stagg (Kildare North, Labour)
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We are not trying to deflect the Minister. The Minister needs to talk to Deputy Devins.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have spoken to Deputy P. J. Sheehan about the matters he raises.

Emmet Stagg (Kildare North, Labour)
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It is Deputy Devins the Minister needs to speak to now.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Undiluted and unequivocal accountability and responsibility are issues I take seriously. We must be responsible for our actions or inactions. That is what political accountability is about.

Brian Hayes (Dublin South West, Fine Gael)
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That is correct.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have established a Health Service Executive to implement Government policy on health care, to be responsible for the delivery of services. I did not dream up the HSE one day. All the advance reports examining our health system advised strongly that for 4.3 million people we should have a single entity instead of effectively 11 boards.

Alan Shatter (Dublin South, Fine Gael)
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The Minister has in reality retained those 11 boards.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Naughten, Deputy Shatter's colleague, was enthusiastic about it.

Alan Shatter (Dublin South, Fine Gael)
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The Minister has superimposed the HSE on the health boards.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Minister to continue without interruption. The Minister has only ten minutes left.

Seán Barrett (Dún Laoghaire, Fine Gael)
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It is accountable to the Minister. That is the whole point. The Minister is responsible. She was elected.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I accept that. Of course I was elected. That is why I am here.

Seán Barrett (Dún Laoghaire, Fine Gael)
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The people did not elect the HSE. They elected the Minister and she is responsible.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I accept that.

Seán Barrett (Dún Laoghaire, Fine Gael)
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The Minister should forget all the other stuff. That is where the problem is. The Minister is not accepting her responsibility.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Barrett will have his own chance to speak.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The board of the HSE is appointed by the Government and me and it is accountable to me. I have asked the chairman of the HSE to carry out a full inquiry relating to these matters, particularly the subject of how patients were managed from the time the HSE became aware of the issues surrounding the situation in Portlaoise. The board met this evening and that process will be put in place.

Alan Shatter (Dublin South, Fine Gael)
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Unless the bureaucracy is radically improved there will be more situations like the one in Portlaoise.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy was his party's spokesperson on health for three years and made no impression.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I ask Deputy Shatter to allow the Minister to finish her contribution.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The board of the HSE is made up of honest people, many of whom work in the public sector, some of whom come from the private sector, all of whom give a huge amount of time to their tasks. Mr. Michael McLoone comes from Donegal and the poor man has been subjected to terrible criticism for missing meetings due to personal issues. Notwithstanding the fact that the organisation is three years old, there are, of course, issues to be addressed and I acknowledge this, as would Professor Drumm, the board members or any objective person. There has never before been a change process programme on this scale in Ireland, in the public sector or private sector, so of course there will be issues, teething problems and difficulties relating to vested interests and people who do not want change.

Earlier this evening I was accused, once more, regarding my ideology. I said at the outset that I am elected by the ordinary women and men of west Dublin who work in the public and private sectors. I do not think there is a stockbroker, barrister or property developer among them. I am not here to represent the rich as they can always look after themselves. My ideology supports innovation, finding solutions and getting rid of obsolete practices.

Ruairi Quinn (Dublin South East, Labour)
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What about co-location?

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is a fine example because co-location is widely available in all of our public hospitals. Nearly half of the patients in the hospital in my constituency last year were private. They were housed in a public hospital funded and staffed by taxpayers and I want to change the fact that some patients are treated on a preferential basis. This is at the heart of the review of the consultants' contract because we wish to ensure the public hospital system is accessible on the basis of medical need and no other basis.

I have been asked to resign but quitting is a shortcut to failure and I do not accept failure. One should not run away simply because the going is tough; one must stay the course. I invite Deputy Kenny, who has joined us, to take the kind of approach to cancer care that we did to the issue of Northern Ireland. I am not requesting a carte blanche on all areas of the health service but ask only that we apply this approach to cancer care.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister should look at the people beside her.

Ruairi Quinn (Dublin South East, Labour)
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We did not receive such co-operation from Fianna Fáil in the past. Does the Minister remember the Anglo-Irish Agreement?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do remember because on this day 22 years ago I voted in favour of it, but we have all moved on a long way since then.

I may not be objective in this matter but I reject the motion of no confidence in me. Patients come first, the cancer plan will be implemented and I will fully support Professor Keane and the team he assembles. I guarantee that I will leave no stone unturned when working day in and day out to ensure the plan becomes a reality sooner rather than later.

James Reilly (Dublin North, Fine Gael)
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I wish to share my time with Deputies Enright and Flanagan.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

James Reilly (Dublin North, Fine Gael)
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I have been a Member of this House only for five or six months and the Minister's performance is the best I have seen from any Minister to date. Today is the first time I have seen raw emotion and the first time I have seen the Minister speaking without notes for quite a while.

James Reilly (Dublin North, Fine Gael)
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I did not speak during the Deputy's speech and ask that the same courtesy be extended to me.

I have a question for Dr. Devins and those on the other side of the House. Why is it only when the Minister's job is on the line that we see this emotion, devotion and talk of patient-centred care? This Minister talks the talk but she does not walk the walk. She provides over a health system that runs from crisis to crisis, is dysfunctional and fails the people of Ireland who pay for it. Yesterday she talked tough about not going off the pitch and she has done the same thing again tonight. We expected no less. If anything has become clear in recent months, in Portlaoise and elsewhere, it is that talking a good game is not enough and it is no match for ministerial action.

The Minister has described herself as having responded speedily, quickly and thoroughly but on 2 November she released a statement that the review phase of the radiology breast diagnosis would be completed within a week. It took 18 more days and only on 20 November, when the Minister, Deputy Harney, was preparing for parliamentary questions, was she finally given the results of the review and the terrible news that two more women had been misdiagnosed and that the total number of women who now had cancer was nine. Like the Minister, I wish those women well and a speedy and full recovery.

I do not know how the Minister can describe her actions as speedy, quick and thorough. On 7 November, during Dáil statements on the Portlaoise situation, the Minister said that Dr. Ann O'Doherty had been asked to look at all mammograms, ultrasounds and anything else relevant. However, she says it was not until 22 November, at the Joint Committee on Health and Children, that she realised a review of ultrasounds was taking place. How speedy, quick and thorough was that?

On 7 November, during the same Dáil debate the Minister said the last thing one could accuse Dr. O'Doherty of was not being independent. Yet, on 22 November, at the Joint Committee on Health and Children, the Minister said she became aware two weeks previously that she was on the interview board. How can somebody who was on the interview board that appointed a consultant on administrative leave, and who may have expressed reservations about the competence of the consultant, not have a potential conflict of interest or be deemed to be an independent arbitrator in this case? This is hardly speedy, quick and thorough action.

The Minister has a serious credibility problem. She came to her Department three years ago with a strong reputation as an achiever, and nobody will deny her past achievements, but today is not about reputations. Today is about the health of a nation and how the State, through the Department of Health and Children that is run by the Minister, and the HSE deliver health care. The Minister designed the HSE with her Cabinet colleagues and implemented it in the Health Bill on 23 November 2004.

In January this year the Minister said there would be no cutbacks in the health service but in September she introduced them. She said patients would come first and that they would not be affected by the cutbacks, but operations were cancelled throughout the country. The Orthopaedic Hospital in Navan was closed and the Minister and HSE made a feeble attempt to suggest only six people would be affected in a unit that carries out 180 operations per month. At least 150 operations were cancelled. The Minister suggested cutbacks would not affect patient care, but home care packages were removed — one from a disabled child suffering from Down's syndrome and cystic fibrosis. The Minister took home help from the elderly and 22,000 bed days were lost in Beaumont Hospital last year, not because of late discharges on Saturdays and Sundays but because beds in the community were not availed of. Those 22,000 bed days are the equivalent of having two wards, each containing 30 beds, closed for a full year.

In 2004 the Minister promised to tackle the crisis in accident and emergency departments through a €70 million ten-point plan but over a year later the number of people on trolleys had doubled. The Minister declared the crisis in accident and emergency departments a national emergency. The reality facing pensioners and seriously ill patients every day involves long delays in overcrowded accident and emergency departments where they lie in fear of contracting methicillin-resistant staphylococcus aureus, MRSA. This is quite a record for the Minister to be proud of — she should hang her head in shame. This Minister cannot provide dignified care for our elderly loved ones in Irish hospitals after ten years of unprecedented wealth.

The Minister promised cervical screening would roll out on 1 January and I pointed out six weeks ago that this was most unlikely to happen. There is only one accredited laboratory to read smears and some tests are being outsourced to the United States. There is no attempt to build up resources and services in the State. Sending smears to the United States will lead to further problems because it increases the likelihood of errors of interpretation on this side of the Atlantic. The Minister has made no arrangements with family clinics and GPs to take smear tests. It is no wonder the promised cervical screening programme is now delayed until March 2008. Can this be achieved, given the lack of preparation?

Women continue to await the roll-out of the BreastCheck programme, which was promised many years ago but has been subject to forever moving deadlines. The Minister promised centres of excellence for cancer care by 2011. However, following statements by Professor Drumm that they could not be delivered until 2015, through public private partnerships, she panicked and announced they would be ready by 2010. Has anybody asked Professor Keane whether he closed down existing services in British Columbia before opening new services? I doubt very much that he did.

Mary Harney (Dublin Mid West, Progressive Democrats)
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He did the two together.

James Reilly (Dublin North, Fine Gael)
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The Minister promised these wonderful centres of excellence some time in the future while simultaneously stripping existing services with immediate effect in 13 hospitals throughout the State. These cutbacks involved a reduction in breast cancer services in Galway from five days to three days per week, despite its being one of the designated regional centres of excellence which was to serve the same people from whom the existing services were stripped. This is a classic case of the Minister promising excellence tomorrow while taking away the services that deliver today. We are promised a nirvana that will never be reached.

The Minister denied she knew anything about the problem at Barrington's Hospital until the summer of 2007, but letters were passing back and forth between her Department and the HSE from January 2006. The Minister did not know about this, however, because she was otherwise engaged. Likewise, she denied knowing until August about the problems with the radiology service in Portlaoise, but a letter highlighting the difficulty was sent to her in July 2005.

Mary Harney (Dublin Mid West, Progressive Democrats)
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And it was acted upon.

Deputies:

It was passed on.

James Reilly (Dublin North, Fine Gael)
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I heard what the Minister said on this issue and what John O'Brien of the national hospitals office said. The letter was passed on to the HSE, which passed it on to the network manager, who in turn passed it to the hospital manager. That is the account I received from Mr. O'Brien at the meeting of the Joint Committee on Health and Children last week.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Dr. Hollywood dealt with that, as Deputy Reilly is aware.

James Reilly (Dublin North, Fine Gael)
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The letter was passed on to the hospital manager, who interviewed the consultant concerned, Dr. Naughton. Once it was established that no operations had taken place, that was the end of the matter. The substantive issue in the letter — that the radiology service in Portlaoise was shambolic — was never addressed.

Ruairi Quinn (Dublin South East, Labour)
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Two years later, nothing had been done.

James Reilly (Dublin North, Fine Gael)
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To rub salt into the wound, the very locum who had been providing the service about which he complained was appointed in a permanent capacity. That is somebody taking a hands-on approach.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Is Deputy Reilly blaming me for that?

Joan Burton (Dublin West, Labour)
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Dr. Naughton said he would not be happy for his own wife to use the service.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Reilly should be allowed to continue without interruption.

James Reilly (Dublin North, Fine Gael)
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The Minister did not even read the letter.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Who appointed that person?

James Reilly (Dublin North, Fine Gael)
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At last Thursday's meeting of the Joint Committee on Health and Children, the Minister said it made no difference because it had been dealt with in a thorough and robust fashion.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There was a clinical review.

James Reilly (Dublin North, Fine Gael)
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If the Minister's idea of thoroughness and robustness results in what has been the blackest day in the health service for 25 years, I suggest, on that point alone, that she should leave now and not come back. That type of robustness and thoroughness will be the death knell for many people if it is allowed to be repeated.

Brian Hayes (Dublin South West, Fine Gael)
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Hear, hear.

James Reilly (Dublin North, Fine Gael)
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The worst aspect of Thursday's meeting was the crystallisation it offered of what health care under the Minister's stewardship means. Nearly 600 women's files were reviewed and, as I understand it, the 97 that were identified were handed over to HSE officialdom for the women concerned to be contacted. Somebody made a decision on the Minister's watch to let these files pile up in a heap to be dealt with when he or she was good and ready, instead of identifying and contacting the women immediately. Even without an ounce of ethics, compassion or humanity, good logistics would dictate that these women should have been brought in as soon the problem was identified. Instead, they were all brought together into a health service that is labouring under cutbacks introduced by the Minister and cannot cope.

The worst aspect of this is the attitude it conveys. Women were effectively told that, yes, they may have a cancer in their breasts, that this was known to the HSE since September, but that no action was taken until November when those in control were good and ready — when the cohort and job lot were filled up and the box car was ready to move out of the station. Loyalty to the system has taken precedence on the Minister's watch over duty of care to the patient. It is a despicable, Orwellian concept and it has come about through the Minister's blinkered ideology. It is an ideology that seeks to undermine the public health service and drive people into private insurance so that more private hospitals can be built on private land. What we will have then is profit——

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly has interests in private health care.

James Reilly (Dublin North, Fine Gael)
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With respect, I did not interrupt the Minister.

Mary Harney (Dublin Mid West, Progressive Democrats)
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He should declare his interest in private nursing homes.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Reilly is entitled to be heard in silence just as the Minister was.

James Reilly (Dublin North, Fine Gael)
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Is that the best the Minister can do? I have declared my interest. Will the Minister declare hers?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly has interests in nursing homes, I do not.

James Reilly (Dublin North, Fine Gael)
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Is the Minister's interest in her survival or in the care of patients? She wants us to head down the route of the United States where 50 million people have no health insurance. According to Michael Moore's docudrama, Sicko, 18,000 people die there every year because they cannot access medical care. The Minister may not admit it but many on the Government benches recognise that if profit becomes the bottom line in private hospitals, patient care will take second place.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly is involved in private nursing homes.

James Reilly (Dublin North, Fine Gael)
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People forget that the old private hospitals were run by voluntary agencies, mainly religious, and were not for profit. The Minister has demonstrated that she is disengaged.

How much time do I have left a Cheann Comhairle?

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy has eight minutes remaining if his colleagues are taking five minutes each.

James Reilly (Dublin North, Fine Gael)
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That is good. Where was I?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly was attacking me.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Reilly without interruption. The Deputy should address his remarks through the Chair so as to avoid some of the argy-bargy.

James Reilly (Dublin North, Fine Gael)
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I am not attacking the Minister but rather her policy and her professionalism. She has taken no proper responsibility in her Ministry for accountability and transparency. There is no accountability on the other side of the House. We have a Taoiseach who does not take responsibility for his own affairs and does not hold his Ministers to account. Is it any wonder that this percolates through the system?

Deputies:

Hear, hear.

James Reilly (Dublin North, Fine Gael)
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The Minister has clearly demonstrated that she is disengaged and has no appetite for taking responsibility. She talks the talk but does not walk the walk. She tried to mislead the Dáil in regard to her actions and lack of action. She tried to mislead the Oireachtas Committee on Health and Children in regard to the inquiry at Portlaoise General Hospital.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I ask the Deputy to withdraw those remarks.

James Reilly (Dublin North, Fine Gael)
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I will not.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I know Deputy Reilly is not long in this House, but that is a serious allegation. I will not accept it.

James Reilly (Dublin North, Fine Gael)
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The Minister allowed the Taoiseach to tell this House that the first she knew of the issue at Portlaoise was in August 2007.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes.

James Reilly (Dublin North, Fine Gael)
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The Minister received a letter regarding the problems at Portlaoise in 2005.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Correct.

James Reilly (Dublin North, Fine Gael)
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I will ask the Irish people to make up their mind on that, not the Minister or those who follow her sycophantically on this issue. She has supported them and they will support her.

Why did the Minister not know about the ultrasounds? Did she not read her own terms of reference?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have explained that there was a clinical review.

James Reilly (Dublin North, Fine Gael)
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There is an issue regarding the independence of the doctor the Minister appointed to read mammograms. Dr. Ann O'Doherty is a person of impeccable clinical ability and is held in high regard. I have no difficulty with that whatsoever. However, the Taoiseach told this House that she would review everything, that staff, equipment and quality assurance issues would form part of her report. How could Dr. O'Doherty report on staff when she was a member of the interview board that appointed the member of staff whose work was in question? My understanding is that Dr. O'Doherty may have expressed concerns about this person's suitability, given her lack of experience in mammography. If Dr. O'Doherty exonerates her, people will point to the fact that it was Dr. O'Doherty who appointed her. If she finds against this person, the latter could say that Dr. O'Doherty was biased against her from the beginning. The Minister has placed Dr. O'Doherty in an invidious position.

Brian Cowen (Laois-Offaly, Fianna Fail)
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A moment ago the Deputy said Dr. O'Doherty was a person of impeccable credibility.

James Reilly (Dublin North, Fine Gael)
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Is this the first contribution to this issue by the Minister, Deputy Cowen, even though Portlaoise is in his own constituency——

Brian Cowen (Laois-Offaly, Fianna Fail)
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I will make my contribution to the debate tomorrow.

James Reilly (Dublin North, Fine Gael)
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——where he held the purse strings?

Brian Cowen (Laois-Offaly, Fianna Fail)
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I know far more about this issue than does Deputy Reilly.

James Reilly (Dublin North, Fine Gael)
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The Minister could have put in place——

Brian Cowen (Laois-Offaly, Fianna Fail)
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I look forward to making my contribution tomorrow.

James Reilly (Dublin North, Fine Gael)
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The Taoiseach stood in this House and told us clearly that there would be triple assessment and pathology, but then he said it never happened. Why did it not happen in the Minister for Finance's constituency?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy should ask Deputy Charles Flanagan beside him.

Charles Flanagan (Laois-Offaly, Fine Gael)
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I will deal with that in a minute.

James Reilly (Dublin North, Fine Gael)
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In the past four months, details have been leaked about the concerns over the reading of pathology slides in Cork University Hospital, which reportedly resulted in at least 15 cases of misdiagnosis. Some 15 patients were probably walking around with cancer as the relevant memo states there were signs of malignancy and signs suggestive of malignancy.

This went on for four months while the HSE dithered and went into denial as it tried to figure out how best to limit damage to the HSE instead of focusing on the patients and their immediate need for treatment. The Minister must have read reports in the Daily Mail for the past month and her press officer surely brought the matter to her attention in the daily briefings she receives. To say she could be unaware of the issue beggars belief.

Mary Harney (Dublin Mid West, Progressive Democrats)
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All the patients were dealt with appropriately.

James Reilly (Dublin North, Fine Gael)
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I will come to that in a moment. Why has it taken four months to come to a conclusion with regard to the cancer patients in Cork University Hospital?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy should be careful about believing everything he reads in any newspaper.

James Reilly (Dublin North, Fine Gael)
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The confusion remains. As late as yesterday, the HSE stated that all patients had been seen by a specialist but numbers could not be released as more may need to be contacted. Which is it?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The review is not over.

James Reilly (Dublin North, Fine Gael)
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Have all the patients been seen?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy knows the review is not over.

James Reilly (Dublin North, Fine Gael)
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Let us have clarity — the Taoiseach clarified this earlier. The HIQA review is not complete and a previous review, carried out by Cork University Hospital, in the UK——

Mary Harney (Dublin Mid West, Progressive Democrats)
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The pathology review is not over.

James Reilly (Dublin North, Fine Gael)
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There is a memo across——

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am clarifying that the review is not over.

James Reilly (Dublin North, Fine Gael)
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How can it be?

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Reilly should continue.

James Reilly (Dublin North, Fine Gael)
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What it comes down to is that, even with the latest problems, nobody expects the Minister to read mammograms, to be responsible for clinical decisions or to watch every person who is employed, but we expect her to take charge. When letters are written to her highlighting concern, the Minister should ensure they are looked after properly. Thoroughness and robustness should be real rather than a figment of the Minister's imagination, resulting in the disaster that occurred in Portlaoise. The manner in which women were treated arising from that is a further disaster.

The Minister stated on the news on Thursday evening that the first she knew about the issue was on the previous night, Wednesday, in preparing for parliamentary questions. As the parliamentary questions were taken on Wednesday, she must have known on Tuesday night, so what was that about?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I did not know on Tuesday.

James Reilly (Dublin North, Fine Gael)
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There were no parliamentary questions on health on Thursday.

We are at a fork in the road. Will we continue down the Minister's path, where we have been going for a number of years since she took over the Department? This has created a health system rather than a health service and places loyalty to the service ahead of duty of care to the patient. Alternatively, will we strike out on a new road where the reverse is the case and the patient would come first in all events, where we could capitalise on what we saw last Saturday, when doctors came from Dublin and nurses came from Portlaoise and the surrounding areas on their own time and secretaries gave up their free time, and patients were seen, letters were typed, signed and sent out? That is the way the health service should work.

It is an awful shame, if she is taking credit for that, that it takes the Minister's job to be on the line for her to act. That is not acceptable to this House or to me. I ask the people on the far side of the House to ask themselves will they support this Minister and continue down this route or will they make the right decision? Will they support this motion so they can go home and tell their wives, husbands, daughters, mothers and constituents that they made the right decision? The Minister must go.

Charles Flanagan (Laois-Offaly, Fine Gael)
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Well done.

Olwyn Enright (Laois-Offaly, Fine Gael)
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At the outset I wish all the women who have unfortunately found themselves at the centre of this debacle well. I hope those who have been diagnosed make a full recovery. I cannot over-emphasise in the House tonight the hurt and betrayal felt by the women I have met in the past few months, who have found themselves victims of this appalling mess. I share their anger and dismay at how they have been treated.

I accept that the Minister, Deputy Harney, took on the health portfolio with idealism, determination and the best of intentions. She gave a robust defence of her tenure in office tonight. Nobody would deny that she is a great speaker and, whether she speaks about herself or her party, she always has a great knack in talking about taking the hard decisions, not being afraid to take on the vested interests and sorting out the health service, but it is just talk and the people saw through that talk in the general election in most instances.

Brian Hayes (Dublin South West, Fine Gael)
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Hear, hear.

Olwyn Enright (Laois-Offaly, Fine Gael)
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I have never denied that the Minister is a good politician. She stated tonight, more or less, that she has been a great survivor in every election she has contested, but that does not make her a good Minister for Health and Children.

In response to the comments of the Taoiseach, the Minister and the Government in the past few weeks, I do not, nor would any sensible person, expect the Minister or the Taoiseach to sit at the bedsides of sick people, hold their hands and check over every medical decision made. I expect the services set up by the Government, with the people who run them, to have the capabilities to ensure the correct decisions are made.

Responsibility must be accepted by those within the HSE for this mess, but there must be political accountability as well. If there is no political accountability in this instance, will there ever be a decision from the Government that demands political accountability? Clearly there will not, and that does not bode well for what is supposed to be a democratic and civilised society.

When the issue first arose in August, the women involved were given wrong and misleading information. The HSE stated that there was no cause for concern and there was no expectation of any woman having a misdiagnosis or an inappropriate procedure. A few months earlier, the same organisation indicated that the case of Rebecca O'Malley would prove to be an isolated incident, but sadly that has not been the case.

We now see the hollowness of those reassurances. There has been a lack of coherence, urgency and care in the actions of the Minister and the HSE. We were told women would be put first but the Minister, Deputy Harney, immediately passed the buck to the HSE, stating that it would carry out the essential task of providing the women with all the necessary treatment, services and counselling as a matter of urgency. This did not happen, however.

A review was ordered, the terms of reference of which we only discovered today. There is an expectation it will be published this week, but the Minister has informed us it is now with the lawyers. Why can a review not come to her with the full and unbridled truth? Why does it have to go through lawyers? If anyone is entitled to see the full review first, it is surely the Minister.

Bernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is a lawyer, she should know.

Olwyn Enright (Laois-Offaly, Fine Gael)
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There is nothing preventing the Minister from seeing the review.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Publishing it may be a different matter but the Minister should see the full and truthful review.

I spoke to many of the women involved in this issue who told me they are still not getting the best possible treatment. One woman, who spoke to me at the weekend, received a letter from the HSE in October asking her to visit her doctor. It was a very vague letter which did not state exactly what was happening. When she visited the doctor she was told she needed a mammogram. She received no further contact, no counselling, no support and no information. She had to contact St. Vincent's hospital several times. She was first told she would be seen in January, then she was told it would be December. It was only when her doctor repeatedly contacted the hospital that she was given an appointment for last Thursday.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I must call Deputy Charles Flanagan.

Olwyn Enright (Laois-Offaly, Fine Gael)
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The Minister has failed on this issue and she must take political accountability. She should reconsider her position.

Charles Flanagan (Laois-Offaly, Fine Gael)
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How long do I have?

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy will have two minutes tonight.

Charles Flanagan (Laois-Offaly, Fine Gael)
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I would not even be able to deal with the allegation made against me in that time.

The events that unfolded in Portlaoise in recent weeks have lifted the lid on what is a totally dysfunctional health service. I will deal with the letter from Dr. Peter Naughton to the Minister, Deputy Harney, in 2005 warning of grave deficiencies in the services in Portlaoise. The Minister admitted last week that she was not even aware of this two and a half year old letter until a couple of weeks ago. How could such an oversight have emerged? The Minister surrounded herself with political advisers at a cost of €500,000 per year. These are the people in the Department who decide what mail the Minister sees and what she does not see.

Mary Harney (Dublin Mid West, Progressive Democrats)
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They do not.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister is closeted and comforted by political advisers who have no regard for the health services or anything to do with it.

P J Sheehan (Cork South West, Fine Gael)
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Hear, hear.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister stated that Dr. Peter Naughton is a highly respected consultant. If the Minister for Health and Children cannot be bothered, or is denied an opportunity, to read his correspondence, what correspondence is read in the Department? Whose letters does the Minister read if she does not read letters from consultant surgeons in Portlaoise warning her of the shambolic state of affairs in that hospital?

The Minister has displayed a serious lack of judgment by surrounding herself with people who will not refer letters of a crucial nature to her, and pleading ignorance is no defence. Her professed ignorance and lack of sufficient interest has shaken the faith of the entire nation in our health services and has led to a nightmare for thousands of women throughout the country and hundreds of women in the midlands.

In 2005, the Minister's office prevented her from reading correspondence and exercising the ministerial responsibility vested in her. Worse, she has had the opportunity since August to show that she is a capable and competent Minister, but she has failed to take a hands-on approach. Women were told they may have breast cancer in a curt letter from the HSE or on the lunchtime news. For women in that position, every second is like an eternity, yet days passed before the Department or the HSE even opened a helpline. The women were told last week they would be dealt with in Dublin but that was belatedly changed to Portlaoise. One of the women described by the Minister as "brave and courageous" was told last week at the 11th hour that was no bed for her to undergo surgery in St. Vincent's hospital.

Three weeks ago in this House, I posed 12 questions to the Minister. I told her in the morning I was putting the questions in early to allow her officials to give her the answers before the end of the debate. If she had got those answers, or even read those questions, she would not have been in the position of ignorance she was in at the committee before Deputy Reilly last week. The Minister's response to the situation in Portlaoise has been political, as exemplified by her response this evening. She has argued that local interests prevented the so-called centres of excellence for cancer services from being built and singled me out in that criticism. However, she stopped the clock in 2000.

Brian Hayes (Dublin South West, Fine Gael)
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That is correct.

Charles Flanagan (Laois-Offaly, Fine Gael)
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She passed the blame down the line and accepted no role for her and the Government.

Brendan Howlin (Wexford, Labour)
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Will the Deputy move the adjournment of the debate?

Charles Flanagan (Laois-Offaly, Fine Gael)
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I will move the adjournment in a moment, and I beg the indulgence of the House to answer a political allegation that the Minister threw across the House to muddy the waters — she is a past master at doing so. In 2002, Portlaoise hospital was designated a centre of excellence for symptomatic breast disease by then Minister for Health, Deputy Micheál Martin. That designation was approved by the Minister, Deputy Martin, and by the Government of which the Minister, Deputy Harney, was a member. However, the hospital and the issue was starved from 2002 to 2005, and departmental records show that to be the case.

Brian Hayes (Dublin South West, Fine Gael)
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That is the issue.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The inexcusable shortage of necessary resources played a major part in creating the crisis in Portlaoise, dealing with staff, equipment and the lack of will to make progress on issues by the Minister and her predecessors. She cannot blame the Opposition because we were not there.

P J Sheehan (Cork South West, Fine Gael)
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Hear, hear.

Charles Flanagan (Laois-Offaly, Fine Gael)
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I thank the Leas-Cheann Comhairle for allowing me to conclude. Good Government is about the ability to plan, act and manage public services to serve the common good. Taking Portlaoise as a microcosm of the health service, it is clear the Minister has failed dismally to meet the demands of office. The motion stands. The people behind the Minister will say it in the corridors and the canteen, but let them say it in tomorrow's vote, that the game is up.

Deputies:

Hear, hear.